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NUTRITION MANAGEMENT FOR THE

PATIENT WITH CANCER

PURPOSE:

The goal of nutrition management of the patient with


cancer is to provide foods that can be consumed in
quantities that are sufficient to meet protein and calorie
needs, to correct nutritional deficits, to prevent or reverse
immunosuppressant, and to minimize weight loss.

USE:

Changes in diet may be necessary for the patient with


cancer who is at risk for nutrition deficits secondary to
malignancy and/or the effects of treatment.

MODIFICATIONS: A regular diet modified to meet the needs of the individual


is appropriate for the patient with cancer. The following
factors should be considered when providing nutrition
therapy for the cancer patient:
1.
2.
3.
4.

Primary site affected and metastases;


Clinical symptoms;
Type and frequency of therapy implemented and the
potential side effects; and
The effect of malignancy or disease on food and
nutrient ingestion, tolerance, and utilization.

Table F-7 offers suggestions in treating common nutrition


problems associated with cancer and cancer treatment.

ADEQUACY:

All modifications made in the diet for the cancer patient


Have the potential to meet or exceed the 1989
Recommended Dietary Allowances (see Appendix 5).
However, if adequate nutrition cannot be achieved orally,
nutrition support should be considered if this correlates
with the objectives of therapy.

TABLE F-7: APPROACHES TO NUTRITIONAL PROBLEMS ASSOCIATED


WITH CANCER AND CANCER THERAPY
PROBLEM
NUTRITIONAL APPROACH
Loss of appetite and early satiety

Frequent small meals


Increase caloric and protein density of foods
High protein/high calorie supplement
Regular exercise if tolerated
Limit liquids at mealtime
Provide a pleasant mealtime atmosphere

Dry mouth

Increase fluid intake


Select soft, moise foods; add sauce/gravy
Tart foods or hard candy may be used to stimulate
salivation
Avoid alcohol, tobacco and commercial
mouthwashes

Chewing and swallowing difficulties (sore mouth or


throat)

Frequent small meals


Increase caloric and protein density of foods
High protein/high calorie supplement
Cool or room temperature foods
Increase fluid intake
Eat and drink slowly
Select soft, moist foods; add sauce/gravy
Avoid highly seasoned foods
Limit coarse-textured and acidic foods (if they
aggravate the problem)
Avoid alcohol, tobacco, and commercial
mouthwashes.

Taste/smell alterations

Avoid strong odors


Cool or room temperature foods
Use seasonings to enhance food flavors.
For meat aversion, try alternative protein sources

Nausea and vomiting

Frequent small meals


Avoid strong odors
Cool or room temperature foods
Increase fluid intake
Eat and drink slowly
Avoid excessive fat in foods
Limit liquids at mealtime
Avoid highly seasoned foods
Elevate head for 1 hour after meals
Antiemetic per physician

Constipation

Increase fluid intake


Increase fiber intake
Regular exercise as tolerated
Stool softener and/or laxative per physician

TABLE F-7: APPROACHES TO NUTRITIONAL PROBLEMS ASSOCIATED


WITH CANCER AND CANCER THERAPY,
CONTINUED
PROBLEM
NUTRITIONAL APPROACH
Abdominal gas/bloating

Eat and drink slowly


Decrease fiber intake
Small, frequent meals
Avoid gas -forming foods
Regular exercise if tolerated
Limit lactose-containing foods if not tolerated

Diarrhea

Frequent small meals


Cool or room temperature foods
Increase fluid intake
Eat and drink slowly
Decrease fiber intake
Avoid excess fat
Avoid gas -forming foods
Limit liquids at mealtime
Avoid highly seasoned foods
Clear liquids may be helpful initially
Limit caffeine and alcohol
Antidiarrheal medication per physician
Trial avoidance of lactose

CANCER TREATMENT AND POTENTIAL SIDE EFFECTS


In addition to the effects of the tumor itself, surgery, radiation and chemotherapy may
have an adverse effect on nutritional status. Figure F-3 and Tables F-8 and F-9 address
the side effects of cancer therapy which have nutritional implications.

FIGURE F-3: POTENTIAL SIDE EFFECTS OF CHEMOTHERAPY


Stomatitis/ mucositis

Constipation

Xerostomia

Anorexia

Diarrhea

Lactose intolerance

Candidiasis

Dysphagia

Fluid retention

Nausea/vomiting

Dysgeusia

TABLE F-8: SURGERY AND POTENTIAL SIDE EFFECTS


TYPE OF SURGERY
Head and neck area resections

Esophagectomy

IMPLICATIONS
Impaired chewing and swallowing; consider use of a feeding tube
Decreased gastric motility
Decrased gastric acid production
Fistula development
Esophageal stenosis

Vagotomy

Fat malabsorption and diarrhea


Decreased gastric motility
Dumping syndrome (secondary to cutting of pyloric sphincter during
vagotomy)

Gastrectomy

Dumping syndrome
Hypoglycemia
Malabsorption of fat and protein
Deficiencies in iron, calcium, fat-soluble vitamins, and vitamin B

Massive small bowel resection

Vitamin B deficiency
Malabsorption
Fat soluble vitamin deficiencies
Loss of bile salts
Metabolic acidosis
Increased risk of renal stones
Postoperative gastric hypersecretion

Ileostomy and colostomy

Sodium imbalance
Fluid imbalance

Pancreatectomy

Diabetes mellitus
Malabsorption of fat, protein, and fat-soluble vitamins and minerals

TABLE F-9: RADIATION THERAPY AND POTENTIAL SIDE EFFECTS


BODY AREA RADIATED
Upper neck and head area

IMPLICATIONS
Taste alterations and anorexia
Oral mucositis
Mouth dryness and increased saliva viscosity
Decreased sense of smell
Increased incidence of dental caries
Nausea and vomiting
Dysphagia
Trismus (tetany of the jaw muscles)

Lower neck and mid-chest area

Swallowing difficulty and dysphagia


Esophageal inflammation
Esophageal stricture or perforation

TABLE F-9: RADIATION THERAPY AND POTENTIAL SIDE EFFECTS,


Continued
BODY AREA RADIATED
Abdonimal and pelvic area

IMPLICATIONS
Enterocolitis
Chronic diarrhea
Bowel stricture
Fistula formation
Malabsorption of fat, carbohydrate, protein and bile
salts
Fluid and electrolyte imbalances

REFERENCES
1.

The American Dietetic Association. Manual of Clinical Dietetics. 4th edition.


Chicago, IL:
The American Dietetic Association; 1992:387-393.

2.

Oncologic diseases. In: Mayo Clinic Diet Manual: A Handbook of Nutrition


Practices. 7th edition. St. Louis, Mo: Mosby-Year Book, Inc; 1994:293-302.

3.

Mahan LK, Arlin MT. Krauses Food, Nutrition & Diet Therapy.
Philadelphia, PA: WB Saunders, Co.; 1992:625-641.

4.

Block AS, Herman MG, Barcia-Morse R. Dietary Modifications in Disease:


Cancer. Columbus, OH: Ross Laboratories; 1983.

5.

Burgess, J. Cancer therapy. In: Skipper A, ed. Dietitians Handbook of


Enteral and Parenteral Nutrition. Rockville, MD: Aspen Publishers Inc;
1989.

6.

Kouba J. Nutritional care of the individual with cancer.


1989;3:175-182.

7.

Ramstack JL, Rosenbaum EH, eds. Nutrition for the chemotherapy Patient.
Palo Alto, Calif: Bull Publishing Co; 1990.

Nutr Clin Prac.

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